General Permits (4980)

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CERTIFICATION OF EXEMPTION- --
FROM REQUIRING A CAMA PERMIT �oP
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name Phone Number
Address
City State Zip
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the Applicant's signature
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the CAMA Official's signature'
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
Issuing date
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Location:
Phone:
Description of Project:
A " 1
Date Project Reportedly Ccmp-ffete:
ield Rep.
Date of Report: O
(1)' Do the neasured dimensions of the developmen riffer from those
indicated in the permit .and plat?. Yes / o Have all permt
conditions been satisfied? es No
COIF=NT :
(2) Sedinientatign anC erosion Control: Has PermSc=CECf Craccedf
or c t-her-ri ise sta-- 111Z ed all disturbed areas: No
COIC�E- NT
I
(3) Future Mcni tcrinc and rnforCE'ent P_C I_ r further lnvesti aaticn
or enforcement action needed? Yes / No
CODE NT :